Provider Demographics
NPI:1649214636
Name:WALTER, KRISTIN (MD)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 N SHERIDAN RD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-935-5556
Mailing Address - Fax:773-935-2724
Practice Address - Street 1:2845 N SHERIDAN RD
Practice Address - Street 2:SUITE 710
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-935-5556
Practice Address - Fax:773-935-2724
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113404207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113404OtherSTATE LICENSE
K21033Medicare ID - Type Unspecified